Complementary and Alternative Medicine
Summary of Key Points
• Complementary and alternative medicine encompasses various approaches to all aspects of medical assessment and management that are not commonly or extensively applied or recommended by conventional western medical practitioners.
• Complementary and alternative medicine approaches are frequently used by patients, but patients often do not discuss their use of these approaches with their health care team.
• Some products purported to be dietary supplements may be unsafe for patients with cancer because of adverse effects of the natural components, adverse interactions with medications, contamination with toxic compounds, or adulteration with drugs.
• St. John’s wort and potentially various other herbal products can significantly alter the pharmacokinetics of certain chemotherapy drugs, such as irinotecan.
• High-dose alpha-tocopherol (i.e., 400 IU per day) should not be given to patients with head and neck cancer who are receiving radiation therapy with curative intent.
• Acupuncture can be useful for managing cancer pain and postsurgical pain.
• Exercise can be an effective intervention for preventing and managing cancer-related fatigue.
• Yoga may be effective in preventing or managing fatigue and improving sleep and quality of life in patients with cancer.
• Acupuncture, ginger, hypnosis, relaxation therapy, and imagery can provide additional relief from chemotherapy-induced nausea and vomiting in patients receiving standard antiemetic regimens.
• High-dose oral glutamine and intravenous glutathione may decrease the frequency of neuropathy from drugs containing paclitaxel and platinum.
• Preliminary evidence indicates that acupuncture may effectively decrease hot flash symptomatology in women undergoing treatment for breast cancer and in men receiving androgen-deprivation therapy for prostate cancer.
• Aloe vera or honey taken orally and intravenously administered glutamine may decrease the incidence or severity of chemotherapy-induced oral mucositis.
• Several interventions have been found useful for stress reduction and to increase the quality of life among patients with cancer, including music, meditation, relaxation therapy, and imagery therapy.
1. A 51-year-old man with a recurrent gastrointestinal stromal tumor of the duodenum starts taking imatinib, 400 mg orally daily, and the initial follow-up computed tomography scan at 2 months shows a 25% decrease in the longest dimension. However, a repeat scan 2 months later shows slight regrowth of the tumor. Before making a change in the patient’s management, you decide to gather more information from the patient about new medications or dietary supplement use. The patient reports that he started taking an herbal product—he does not know the name or its contents—to help with the recent onset of depressive symptoms. You ask him to stop taking the supplement and bring in the labeling information for your review. What herb is most likely included in this product that could be affecting the blood levels of imatinib?
2. A 55-year-old woman with stage II non–small cell lung cancer has undergone surgical resection of the tumor and is receiving adjuvant cisplatin and docetaxel. She experiences severe nausea and vomiting after her first cycle despite pretreatment with Decadron and granisetron and prochlorperazine, as needed. What would be appropriate complementary approaches to consider adding to the antiemetic regimen?
A Acupuncture/acupressure at the P6 acupoint
B Ginger extract at a dose of 0.5 to 1.0 g daily in two divided doses
D St. John’s wort, 300 mg orally, three times a day, starting the day before chemotherapy and for 3 to 4 days after
3. A 42-year-old woman undergoing adjuvant chemotherapy for stage II breast cancer is experiencing difficulty getting to sleep and frequent bouts of moderate to severe fatigue. What complementary approaches have been demonstrated in randomized controlled trials to improve both of these complaints in a cancer population?
1. Answer: C. Extracts of the flowers and leaves of Hypericum perforatum (St. John’s wort) have been promoted and used as antidepressants. Hyperforin, and perhaps other components of these extracts, induce cytochrome 3A4 expression in hepatocytes, thus affecting the metabolism of various drugs, including imatinib and irinotecan.
2. Answer: E. Stimulation of the P6 point via acupuncture or acupressure, ginger extract, and hypnosis have each been demonstrated in randomized controlled trials to improve control of chemotherapy-induced nausea in patients with cancer. St. John’s wort has not been studied for this indication.
3. Answer: E. Both yoga and acupuncture have produced improvements in parameters of sleep and cancer-related fatigue in randomized controlled trials. Both Asian and American ginseng have shown beneficial results on cancer-related fatigue, but the effects on sleep have not been studied. No trials have been reported of the use of vitamin E for either cancer-related fatigue or sleep disturbances.
